Diabetes

DRESSED in a purple mix ankara gown, Felicia Akinrinmade lay forlornly on the narrow hospital bed that morning. She looked lean and pale, which is not surprising considering the ailment she has been battling with for years and which led to her admission in the hospital in the first place. The 33-year-old housewife is a diabetic patient on admission at the Ajeromi General Hospital, Lagos. She was first diagnosed with the ailment about 10 years ago when she was 23. “It was during my first pregnancy when I was 23 that I got to know about my condition,” she told The Nation. Unfortunately, she lost that first baby due to the disease. “My first born died because of the disease. Even the second one I had is affected by diabetes,” she stated sadly.

The disease, she lamented, has become a serious problem to her because of the cost of managing it. “It’s expensive to manage,” she noted.

Popular musician and crooner, Stella Monye, is another person living with diabetes. The artiste, who shot to fame with her hit tune, Oko mi ye, some years back, first learnt of her condition after two fainting fits or coma caused by the disease. The first incident took place while shopping at the popular Balogun market on Lagos Island. She disclosed in a chat: “I did not just wake up one day and found out that I had diabetes. It was gradual. Twice, I went into coma in a public place. My first experience was at Balogun market in Central Business District area of Lagos Island. It actually happened while I was shopping there. While my second experience was at the Muritala Mohamed International Airport on my way out of the country. In both cases, I just blacked out and did not come round for several hours. It was a taste of death so to say. But even after those two attacks, ironically, I had no knowledge that I had become a diabetic. So, I did not understand why I had gone into coma.”

The Samba Queen as she is also popularly known from her kind of music, became alarmed at her health condition and decided to seek help. Upon approaching medical experts, she was diagnosed as a diabetic. It took her sometime to digest the meaning and the implications. “Initially I was not scared. But the doctors explained the implications and informed me that if not well managed, it could kill very fast. So that scared me!” she said.

“I suddenly realised that I had a difficult health condition to battle. Confirmation in my case also meant that treatment must be embarked upon. So I summoned courage and strictly embarked on the medication prescribed to me by my doctor. I also adhered to the foods prescribed as part of the crisis management approach, a point which I had already got to, which is quite expensive when you consider the cost of the drugs and all other things put together.”

In terms of number, diabetes is the fastest growing long-term disease that affects millions of people worldwide. Figures from the International Diabetes Federation (IDF) indicate that over 371 million people have diabetes and half do not know they have it. The world’s most populous country, China, tops the list of 10 countries with the highest number of people; 92.3 million between the ages of 20 and 79 years are said to be suffering from the diseases.

Statistics for Nigeria are equally frightening. IDF 2012 figures show that over three million Nigerians between the ages of 20 and 79 years have diabetes, while 2.5 million Nigerians living with the condition are unaware and undiagnosed. It also showed that the country lost 88,681 persons in 2012 due to diabetes-related illnesses and has a 4.83 per cent comparative prevalence, according to the World Health Organisation (WHO) standard.

These figures indicate that Nigeria led other African countries in diabetes, closely followed by South Africa with 1.9 million people having the disease.

So, what is it about this disease that is afflicting so many, causing deaths and disabilities everywhere?

The silent killer

Diabetes is a condition in which the person has high blood glucose (blood sugar) either because insulin production is inadequate or because the body’s cells do not respond properly to insulin or both. Patients with high blood sugar will typically experience polyuria (frequent urination), become increasingly thirsty (polydipsia) and hungry (polyphagia). If you have diabetes, no matter what type, it means you have too much glucose in your blood, although the reasons may differ.

Glucose is vital to the health because it’s an important source of energy for the cells that make up the muscles and tissues. It’s also the brain’s main source of fuel. But too much glucose can lead to serious health problems. What makes diabetes such a serious ailment is that it can go undiagnosed for years, with many sufferers living with it without being aware they have it. This is the reason it’s often called the ‘silent killer.’

“Diabetes is the elevation of sugar in the blood as a result of insufficient insulin or insulin deficiency,” said a medical practitioner, Dr Saheed Ogunmola. He noted that the disease is caused by excess intake of fine sugar. “It is not when someone takes sugar the first time but sugar that is stored in the body and is not digested.”

“Also diabetes has two types : Type 1 and Type 2. Type 1 is hereditary, genetic and is common among mothers and children, that is children inherit it from the mother. Type 2 is common among the middle aged people and the elderly,” he said.

“In type 1, the body does not produce insulin. Some people may refer to this type as insulin-dependent diabetes, juvenile diabetes or early-onset diabetes. People usually develop type 1 diabetes before their 40th year, often in early adulthood or teenage years.” Approximately 10% of all diabetes cases are type 1. Patients with type 1 diabetes will need to take insulin injections for the rest of their life. They must also ensure proper blood-glucose levels by carrying out regular blood tests and following a special diet,” Ogunmola added.

In Type 2 diabetes, the body does not produce enough insulin for proper function or the cells in the body do not react to insulin (insulin resistance). “Type 2 is common among the middle age,” he stated, noting that 90% of all cases of diabetes worldwide are of this type.

On the ailment, Dr Godwin M. Inwang, Senior Medical Officer of St. Luke’s General Hospital, Uyo, Akwa Ibom State, stated: “Diabetes is a disease which results from the poor management of glucose in the body. Diabetes could be divided into two; the first is Diabetes Insipidus, which is directly the poor management of sugar in the body. Diabetes Malytus manifests in different forms, basically the problem of poor sugar management in the body, caused by either the lack of insulin or the non-sensitivity of the body cells to insulin.”

He stated that Insulin is a hormone secreted in the pancreas in the abdomen, which sensitises the cells to admit sugar and pass on to the body. “Basically, all the foods that we eat turn into some form of sugar that can be used by the body. And that primarily is glucose. When there is no sugar in the body, it starts breaking down protein and eventually turns it into sugar for the body. For instance during starvation, when the body does not get sugar from foods, it starts breaking down the fat cells to turn into sugar. These are called ketones. They are burned to produce energy for the body.”

Describing the body as a big chemical laboratory that does all sorts of things, he added: “It is similar to a factory. When there is a lack of insulin, then you can say someone has insulin-dependent diabetes, which is Type 1. When it is as a result of the cells not recognising the presence of insulin, it is called Type 2. The second one could also be caused by the fact that a body has so much insulin but the insulin is not functioning the way it should be functioning. This could be as a result of obesity. Maybe the person is so big, has so much single unit substances and too much fat. Type 1 diabetes basically affects children and younger people. However, it can also be found among older people, while Type 2 affects more of the older people.

On how she manages the sickness that has no discernible cure, Stella Monye, the music star, admitted that she endeavours to manage it as best as she can. Said she: “Though, it hasn’t been easy because already my heart has been affected. That is what diabetes does. Most often, it affects your heart first and goes on to attack your kidneys.”

In the past, diabetes was associated mostly with the elderly and middle aged persons. Now, the young too, including children, are affected. Fourteen-year-old school girl, Sandra Ogochukwu, is one of such children whose lives have been blighted by the incurable disease. She was first diagnosed for Type 1 diabetes at 11 in 2010. She has been on medication since then which includes regular shots of insulin as she has insulin-dependent diabetes. She also has to stay away from sugar and sugary foods. On this, her mother, Madam Janet, stated: “It’s tough keeping her away from sugar as she has a sweet tooth. We can monitor her when she’s at home but at school, nobody is there to keep an eye on her so she can stay away from soft drinks and other sugary treats like biscuits and cakes she likes so much. I keep praying that she listens to my pleadings and those of the doctor to avoid such things as it could worsen her health.”

On why the disease affects children and other young people, Dr Inwang said: “It’s the same reason- lack of insulin. Maybe the child has a disease that affects the pancreas, which affects the cells that produce the insulin, or not just able to produce insulin, or has been taking things that require so much use of insulin that the body burnt out its reserves. For instance, somebody who has had a steady long habit of drinking too much of sugar and non-sugar sweetened things is likely to have it. It is even worse with people who are used to taking non-sugar sweetened things. Because if you take sugar, the brain is sensitive enough to sort it out and decide what quantity the body needs and communicate such message to the necessary cells.

“But in the case of non-sugar sweetened substances, the brain cannot decode it. And that causes a lot of chaos in the body. You know, people say ‘do not take sugar but take sugar substitute,’ I tell you it is worse because some of those non-sugar substances contain dangerous compounds. That is because if insulin comes around and does not see sugar, after the sweet taste has attracted it, it causes a whole lot of complexities for the body such as hunger, excessive eating as a result of over stimulation. It is a complex thing because there are so many hormones in the body dealing with insulin.

In Type 2 diabetes, the body has excess insulin, but the insulin is not effective for the body. “Everybody can be affected,” said Ogunmola. “Even children are not left out. It’s because the intake of sugar by this set of people is much, which can lead to diabetes,” he explained.

A lifelong ailment

Since diabetes has no cure, those who have it have to learn to live with and manage it well to avoid complications. Experts warn that if not well managed, it can cause death. “Diabetes is deadly, very deadly,” affirmed Inwang. He added: “Diabetes is deadly because it is associated with various types of complications. One of such complications is that it can lead to sudden death. In the younger people, there is so much insulin in the body which is not used and eventually it leads to coma. If the person is not treated immediately, the person can die. Even if you treat immediately, if you are not careful, you will still lose the person to death.”

“There is so much that too much sugar in the body does. It draws water away from the cells and makes the cells flabby, makes the person dehydrated; increases acid in the body, and then it affects the heart, liver, practically every other organ of the body. Diabetes is very dangerous.”

“Diabetes is usually managed and cannot be treated,” Ogunmola noted, stating that the patient ‘lives with it till death.’

On the symptoms, Inwang said: “Early symptoms could show in one being thirsty too often. Not just the love of water but being really thirsty too often. Also, when one complains of thirst too much and passes lots of urine too often. This could be because there is a lot of sugar in the body but it is not entering the cells. It is when sugar enters the cells that the body is satisfied because the cells have something to use, which produces energy. But if sugar does not go to the cells, the person remains hungry and thirsty. Though he will continue to eat! Other symptoms are weakness of the body and obesity.”

“From my experience, the symptoms come in different forms,” stated Monye. “In some cases, it makes one vomit from time to time; sometimes it puts you in a sort of temporary coma, and you can also be dizzy and weak. At such times, the digestive system does not function well.”

Managing diabetes

To manage the ailment, experts advocate proper medication as well as a healthy lifestyle. “If you indulge in taking a lot of sugar, you will burn out your pancreas,” Inwang warned. “You have to eat rationally and sensibly. Most recommended diet in order to avoid diabetes is to eat farm-fresh foods. Avoid processed foods and you will improve your chances of getting healthy nutrition,” he advised. He also advised people to avoid living an excessive lifestyle, stating: “What you eat or drink contributes a lot to getting diabetes or not. Do not live an excessive life. Do not take unhealthy drinks and avoid sugar and non-sugar sweetened foods.”

He noted that patients may be able to control their Type 2 diabetes symptoms by losing weight, following a healthy diet, doing plenty of exercise, and monitoring their blood glucose levels. “However, Type 2 diabetes is typically a progressive disease – it gradually gets worse – and the patient will probably end up having to take insulin, usually in tablet form.”

Having lived successfully with diabetes for quite a while, Monye has some tips for people who may be diabetic or just discovered that they are. “It has a lot to do with the foods that we eat. I would say that such people should eat and drink right. Eating and drinking right is very important! They should also drink a lot of water. Being diabetic also means that you have to find out about the illness. You have to learn to do research about what diabetes is all about and how you can cope. There are newer discoveries from time to time and a diabetic is better placed if you keep in touch with growing knowledge. You could search for such knowledge on the internet. They should search on the Net for the right things to eat to avoid diabetes.”

Apart from the genetic factor, experts point out that some people are at risk of diabetes due to their weight and lifestyle choices. For instance, overweight and obese people have a much higher risk of developing Type 2 diabetes compared to those with a healthy body weight. People with a lot of visceral fat, also known as central obesity, belly fat or abdominal obesity, are especially at risk.

Being overweight, physically inactive and eating the wrong foods all contribute to the risk of developing Type 2 diabetes, they warn. Drinking just one can of (non-diet) soda per day can raise the risk of developing Type 2 diabetes by 22%, researchers from Imperial College London reported in the journal Diabetologia. The scientists believe that the impact of sugary soft drinks on diabetes risk may be a direct one rather than simply an influence on body weight.

If badly controlled, complications can arise with diabetes. Some of these, according to Ogunmola, include male infertility, low ejaculation, Erectile dysfunction (male impotence), obesity, eye complications such as glaucoma and cataracts, foot complications (neuropathy, ulcers and sometimes gangrene, which may require that the foot be amputated) and skin disorders.

Others are heart problems, hypertension (common in people with diabetes, which can raise the risk of kidney disease, eye problems, heart attack and stroke), mental health (uncontrolled diabetes raises the risk of suffering from depression, anxiety and some other mental disorders), hearing loss, gum disease, healing of wounds (cuts and lesions take much longer to heal in diabetics), among others